MEDICARE: BRESHELLE COLLINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1518398213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRESHELLE COLLINS

Provider Business Mailing Address
First Line	:	5135 CAMINO AL NORTE STE 261
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2419
Country	:	US
Telephone Number	:	702-853-6727
Fax Number	:	702-853-6728

Provider Business Practice Location Address
First Line	:	5135 CAMINO AL NORTE STE 261
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2419
Country	:	US
Telephone Number	:	702-853-6727
Fax Number	:	702-853-6728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	12/05/2013

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1447681358 — BRIANNA COLLINS
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Directions to “ BRESHELLE COLLINS ” Practice Location

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